Fruit production and consumption: practices, preferences and attitudes of women in rural western Kenya

Relationship of dietary intake between children aged 12-59 months and their mothers in rural Kenya: a cross-sectional study in two seasons

OBJECTIVE

The aim of the study was to investigate the quantitative association between the dietary intakes of children and their caregivers.

METHOD

In this cross-sectional study, a non-consecutive 2-day 24-h dietary recall was conducted in two seasons. Participants comprised 142 pairs of 12-59-month-old children and their female caregivers from rural areas of Kenya. Energy and micronutrient adequacy, food group intakes and food allocation were assessed. Differences and correlations between caregiver and child diets were examined, and multiple regression analysis was used to investigate the relationship between the children's and caregivers' dietary intakes.

RESULTS

The child's diet was significantly lower in energy and higher in micronutrient adequacy than was the caregiver's diet (p < 0.001). Specifically, the child's diet contained more fruits, dairy products, sugar and confectionaries per 4184 kj. Children were allocated relatively more dishes containing nutrient-rich foods than staple foods. The correlation coefficients between the dietary intake of caregivers and children were stronger among 24-59-month-old children. After controlling with covariates, caregiver energy intake was significantly associated with child energy intake (standardised beta [β] = 0.512, p < 0.001), and caregiver micronutrient adequacy was associated with child micronutrient adequacy (β = 0.679 and β = 0.262 after energy adjustment, p < 0.001).

CONCLUSIONS

The dietary intakes of caregivers and children were closely related. The children had a more nutrient-rich diet compared to that of their caregivers. Differences in food group intakes and food allocation may contribute to the higher nutrient adequacy of children. There is a need to improve the diet of caregivers, which would contribute to improving the diet of children.

Nutritional, Physico-Chemical, Phytochemical, and Rheological Characteristics of Composite Flour Substituted by Baobab Pulp Flour (Adansonia digitata L.) for Bread Making

The aim of this paper is to improve the nutritional quality of bakery products by replacing wheat flour (WF) with different proportions (10%, 20%, and 30%) of baobab flour (BF). The composite flours and bread obtained were evaluated from nutritional, physical-chemical, phytochemical, organoleptic, and rheological points of view. The results obtained show that BF is a rich source of minerals (K: 13,276.47 ± 174 mg/kg; Ca: 1570.67 ± 29.67 mg/kg; Mg: 1066.73 ± 9.97 mg/kg; Fe: 155.14 ± 2.95 mg/kg; Na: 143.19 ± 5.22 mg/kg; and Zn: 14.90 ± 0.01 mg/kg), lipids (1.56 ± 0.02 mg/100 g), and carbohydrates (76.34 ± 0. 06 mg/100 g) as well as for the phytochemical profile. In this regard, the maximum contents for the total polyphenols content (TPC) were recorded in the case of bread with 30% BF (297.63 ± 1.75 mg GAE/100 g), a total flavonoids content (TFC) of 208.06 ± 0.002 mg QE/100 g, and 66.72 ± 0.07% for antioxidant activity (AA). Regarding the physical-chemical, rheological, and organoleptic analysis, the bread sample with 10% BF (BWB1) was the best among the samples with different proportions of BF. It presented a smooth, porous appearance (73.50 ± 0.67% porosity) and an elastic core (85 ± 0.27% elasticity) with a volume of 155.04 ± 0.95 cm³/100 g. It had better water absorption (76.7%) than WF (55.8%), a stability of 5.82 min, and a zero-gluten index. The scores obtained by BWB1 for the organoleptic test were as follows: Appearance: 4.81; color: 4.85; texture: 4.78; taste: 4.56; flavor: 4.37; and overall acceptability: 4.7. This study shows that BF improved the nutritional quality of the product, organoleptic properties, α-amylase activity, viscosity, and phytochemical profile, resulting in composite flour suitable for the production of functional bread.

Factors affecting fruit and vegetable consumption and purchase behavior of adults in sub-Saharan Africa: A rapid review

In order to achieve the Sustainable Development Goals, considerable dietary shifts, including an increase in the consumption of fruit and vegetables (FV) will be required. However, worldwide consumption of FV is far below international recommendations, including in many low- and middle-income countries (LMICs), particularly in Africa. Understanding what, where, when, and how people choose to eat requires an understanding of how individuals are influenced by factors in their social, physical, and macro-level environments. In order to develop effective interventions to increase fruit and vegetable consumption, the factors influencing consumer behavior need to be better understood. We conducted a rapid review to assess and synthesize data on individual, social, physical, and macro-level factors that enable or constrain fruit and vegetable consumption and purchase among adults living in sub-Saharan Africa. Our conceptual framework is based on a socio-ecological model which has been adapted to settings in LMICs and Africa. We systematically searched four electronic databases including Scopus, Medline (PubMed), PsycInfo, and African Index Medicus, and screened Google Scholar for gray literature. We included a total of 52 studies and narratively summarized the existing evidence for each identified factor across the different levels. We found that most studies assessed demographic factors at the individual level including household or family income, socio-economic status and education. Furthermore we identified a variety of important factors that influence FV consumption, in the social, physical, and macro environment. These include women's empowerment and gender inequalities, the influence of neighborhood and retail food environment such as distance to market and price of FV as well as the importance of natural landscapes including forest areas for FV consumption. This review identified the need to develop and improve indicators both for exposure and outcome variables but also to diversify research approaches.

Fruit and vegetable processing and consumption: Knowledge, attitude, and practices among rural women in East Africa

High post-harvest losses of fruits and vegetables (FVs) limit their supply and availability for year-round consumption. Hence, processing innovations at their production areas could help address this constraint, which requires the need to assess people's perceptions in these areas. Therefore, this study gauged the knowledge, attitude, and practices towards FV processing and consumption and its relationship with actual FV consumption. Surveys were conducted with women in six study sites – three fruit and three vegetable production areas – in Kenya, Tanzania, and Uganda. Quantitative 24-h dietary and 7-day FV recalls were collected across two seasons. Open and closed-ended questions were constructed to assess the women's knowledge, attitude, and practices towards FV processing and consumption. The fruit and vegetable sites included 584 and 732 women, respectively. Average fruit consumption was 4-135 g/day in the plenty season and 4-106 g/day in the lean season. Vegetable consumption was 112-146 g/day and 84-180 g/day in the plenty and lean season, respectively. There were significant consumption differences across seasons. Most women expressed high knowledge of FV processing and consumption benefits and showed a positive attitude towards FV processing and consumption. Yet, in practice, a small number of women process FVs largely due to limited processing know-how and equipment. The relationship between knowledge and attitude and FV consumption was negative or none. The high knowledge and positive attitude expressed, yet the limited processing know-how and equipment should be a basis for interventions to increase FV processing into nutritious products for better nutrition and to ensure their availability year-round.

Gender and Generational Differences in Local Knowledge and Preference for Food Trees in Central Uganda and Eastern Kenya

Food trees contribute substantially to the food and nutrition security of millions of rural households in Africa. Farming communities prioritize tree and shrub species on farms based on a combination of factors, including their knowledge of potential uses the species' economic potential and a range of constraints and opportunities that each farmer faces depending on their position within the community and the household, in cultivating, harvesting and processing tree products. Gender and age are strong determinants of such constraints and opportunities as well as ecological knowledge and use of tree resources. This study contributes to the understanding of gender and generational preferences for food tree species that determine their use, and which contribute to food and nutrition security in Central Uganda and Eastern Kenya. Sixteen gender and age segregated focus group discussions were conducted to assess food tree species preferences. A total of 61 food tree species were listed −46 in Uganda (including 16 indigenous species) and 44 in Kenya (21 indigenous species). Results showed knowledge on food tree species differed by gender and age, with differences across gender lines found more prevalently in Uganda, and across generational lines in Kenya. Age-related differences in knowledge and preferences were clear with regard to indigenous species, whereby older women and men were found to have the most knowledge in both countries. Among key challenges for food tree cultivation, farming households mentioned knowledge of tree management, the lack of planting materials, especially for improved varieties, prolonged droughts and scarcity of land. Some of these constraints were gendered and generational, with women mostly mentioning lack of knowledge about planting and management as well as cultural restrictions, such as only having access to land when married; whereas younger men indicated management challenges such as pests, limited markets, as well as scarcity and limited ownership of land. Overall findings suggest that consulting user preferences for food tree species and constraints experienced by gender and age group could be important in the design of interventions which involve a diversity of food trees.

Dietary Patterns as Characterized by Food Processing Levels and Their Association with the Health Outcomes of Rural Women in East Africa

Overweight and obesity are rapidly rising in Sub-Saharan Africa including in rural areas. However, most studies focus on urban centers, and have attributed this epidemic to the consumption of processed foods without their clear characterization. This study investigated food intake patterns defined by food processing levels and their association with overweight/obesity in rural areas. Four 24-h dietary recalls, anthropometric measurements, and socio-demographic characteristics were collected from 1152 women in Kenya, Tanzania, and Uganda. The PCA method was used to extract patterns characterized by food processing levels. The association between patterns and overweight/obesity was ascertained with regression models. The overweight/obesity rate was 47%, 42%, 26%, and 38% in Kenya, Tanzania, Uganda, and East Africa (as pooled data), respectively. Several patterns were identified, yet a "plant-based pattern" largely characterized by unprocessed and minimally processed foods and a "purchase pattern" mainly distinguished by highly processed foods were dominant. The "plant-based pattern" was inversely or not associated with overweight/obesity, while the "purchase pattern" had a positive association or no association. A clear distinction on processed foods as healthy and unhealthy should be made based on their nutrient provision to avoid their mischaracterization as unhealthy. Policies to reverse consumption of unhealthy processed foods while promoting healthy ones should be pursued.

Low Daily Intake of Fruits and Vegetables in Rural and Urban Bangladesh: Influence of Socioeconomic and Demographic Factors, Social Food Beliefs and Behavioural Practices

Bangladesh is facing a large burden of non-communicable diseases. As a possible remedy, the WHO/FAO recommends consuming 400 g or five servings of fruits and vegetables every day; however, only a small proportion of the population practices this. The present study sets out to determine the sociodemographic factors that affect this low intake of fruits and vegetables, and the roles that beliefs and behavioural practices play in influencing food consumption. Logistic and ordered logistic regressions were used to identify what sociodemographic factors are significantly influencing fruit and vegetable intake, and to explain the role of social food beliefs. It was found that in Bangladesh 75% of urban and 92% of rural populations consume less than five servings a day. While gender was not found to be a significant factor, housewives appeared to be more at risk of a lower intake of fruits and vegetables. People with higher income, higher education, and who are older were all less likely to have problems with a low intake of fruits and vegetables. Higher education assisted in attaining positive beliefs and behavioural practices regarding food, while residing in a rural community was found to be a significant constraint.

Determinants of Children's Fruit Intake in Teso South Sub-County, Kenya-A Multi-Phase Mixed Methods Study among Households with Children 0-8 Years of Age

Fruits are micronutrient-rich sources which are often underrepresented in children’s diets. More insights into the determinants of children’s fruit consumption are needed to improve nutrition education in Teso South Sub-County, Kenya. A multiphase mixed method study was applied among 48 farm households with children 0–8 years of age. A market survey together with focus group discussions were used to design a formative research approach including qualitative and quantitative data collection methods. The unavailability of fruits and the inability to plant fruit trees in the homesteads were the main challenges to improve fruit consumption behaviour, although a number of different fruit species were available on the market or in households. Perceived shortage of fruits, financial constraints to purchase fruits and taste were important barriers. Fruits as snacks given between meals was perceived as helpful to satisfy children. The mean number of fruit trees in the homesteads was positively associated with fruit consumption. Field trials are needed to test how best fruit trees within home gardens and on farms can be included, acknowledging limited space and constraints of households with young children. This should be combined with nutrition education programs addressing perceptions about the social and nutrient value of fruits for children.

Wild Food Plants and Trends in Their Use: From Knowledge and Perceptions to Drivers of Change in West Sumatra, Indonesia

Wild food plants (WFPs) are often highly nutritious but under-consumed at the same time. This study aimed to document the diversity of WFPs, and assess perceptions, attitudes, and drivers of change in their consumption among Minangkabau and Mandailing women farmers in West Sumatra. We applied a mixed-method approach consisting of interviews with 200 women and focus group discussions with 68 participants. The study documented 106 WFPs (85 species), and Minangkabau were found to steward richer traditional knowledge than Mandailing. Although both communities perceived WFPs positively, consumption has declined over the last generation. The main reasons perceived by respondents were due to the decreased availability of WFPs and changes in lifestyle. The contemporary barriers to consuming WFPs were low availability, time constraints, and a limited knowledge of their nutritional value. The key motivations for their use were that they are free and "unpolluted" natural foods. The main drivers of change were socio-economic factors and changes in agriculture and markets. However, the persistence of a strong culture appears to slow dietary changes. The communities, government and NGOs should work together to optimize the use of this food biodiversity in a sustainable way. This integrated approach could improve nutrition while conserving biological and cultural diversity.

The Impact of Local Agrobiodiversity and Food Interventions on Cost, Nutritional Adequacy, and Affordability of Women and Children's Diet in Northern Kenya: A Modeling Exercise

Wild plant species are often excellent sources of micronutrients and have the potential to promote healthy living, yet they are under-exploited. Distribution of micronutrient powders as diet supplements can play an effective role in reducing micronutrient deficiencies among infants and young children. However, assessing their effects in ensuring a nutritious diet at low cost have been limited. This study assessed the impact of including wild plant species and micronutrient powders in modeled optimized lowest-cost diets for women and children in rural Kenya. Market surveys, focus group discussions in six villages and a 24-h dietary intake recall were used to collect data that were subsequently entered in the cost of diet linear programming tool to model lowest-cost nutritious diets for women and children in Turkana County, Kenya. Three wild vegetables, three wild fruits, and micronutrient powder were added to the models to assess their impact on the cost and the nutrient adequacy of the diets. A locally adapted cost optimized nutritious diet without any intervention costs between 50 and 119 Kenyan shillings (KES) daily ($0.5 to $1.2) for children between 6 and 23 months and 173 to 305 KES ($1.8 to $2.9) for women. Addition of the three wild vegetables resulted in cost reductions between 30 and 71% as well as making up for iron and zinc gaps. The micronutrient powder had an insignificant effect on diet cost and filling nutrient gaps. Edible wild plant species, specifically wild vegetables, can reduce diet costs in considerable proportions while filling nutrient gaps year-round. However, affordability of a nutritious diet remains a major challenge in Turkana County, irrespective of the wealth group.

Meat, fruit, and vegetable consumption in sub-Saharan Africa: a systematic review and meta-regression analysis

CONTEXT

The dietary choices people make affect personal health and have consequences for the environment, both of which have serious implications for the 2030 Sustainable Development Agenda. In global reviews, the literature on meat, fruit, and vegetable consumption in sub-Saharan Africa (SSA) is limited.

OBJECTIVE

This systematic review set out to quantify meat, fruit, and vegetable consumption in SSA populations and to answer the following question: How much meat, fruit, and/or vegetables are being consumed daily by which individuals in SSA over the years?

DATA SOURCES

Following the PRISMA guidelines, the authors systematically searched the MEDLINE, EMBASE, ASSIA CINAHL, Web of Science, POPLINE, and Google Scholar databases to identify 47 (out of 5922 search results) studies reporting meat, fruit, and/or vegetable consumption in SSA populations.

DATA EXTRACTION

Three independent investigators extracted data on year of data collection, study country, study population and geographical context, and population intake of meat, fruit, and/or vegetables.

DATA ANALYSIS

Using STATA SE version 15 software, random-effects meta-regression analyses were used to test the effect of year of data collection and method of data collection on population meat, fruit, and vegetable consumption. The analyses also tested any association between age, sex, rural/urban residence, or a country's economic development and population intake of meat, fruits, and/or vegetables. The review was started in 2017 and completed in 2019.

RESULTS

Richer SSA countries were likely to consume more meat (ß = 36.76, P = 0.04) and vegetables (ß =43.49, P  = 0.00) than poorer countries. Vegetable intake has increased dramatically over the last 3 decades from ≈10 g to ≈110 g (ß = 4.43, P  = 0.00). Vegetable (ß= -25.48, P  = 0.00) consumption was higher in rural than in urban residents. Although the trend of meat consumption has risen (≈25 g to ≈75 g), the trend is nonsignificant (ß = 0.63, N.S.). Daily average per capita meat consumption was 98 g - above the 70 g recommendation - while fruit and vegetable intake (268 g) remain below the World Health Organization's recommendation (400 g).

CONCLUSIONS

Given the low intake of plant-based foods, it is likely that SSA populations may be deficient in high-quality protein and micronutrients as suggested by the EAT-Lancet Commission. There is a need to promote both an adequate supply and demand of plant-based protein and micronutrients, including fruit, vegetables, nuts, seeds, and legumes, in SSA countries. While dietary changes in SSA may offer large absolute benefits, consideration of the magnitude of dietary change, particularly increasing or reducing meat consumption, will need to occur in a way that ensures that policy and interventions support the reduction of undernutrition and micronutrient deficiencies without worsening the prevalence and environmental impacts of noncommunicable diseases. There is also the need for preventive action that ensures that SSA populations do not increase their meat consumption as disposable incomes increase and countries' economic development rises, as is seen in most countries undergoing economic transformation.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42018090497.

Developing fruit tree portfolios that link agriculture more effectively with nutrition and health: a new approach for providing year-round micronutrients to smallholder farmers

A sufficient intake of fruits can alleviate micronutrient deficiencies and reduces the risks of a number of associated diseases. In many parts of sub-Saharan Africa, however, the production and consumption of fruits are inadequate on average and in particular so in specific seasons. To better incorporate fruits into local food systems while addressing the challenge of seasonal availability, World Agroforestry (ICRAF) has developed a methodology based on “fruit tree portfolios” that selects socio-ecologically suitable and nutritionally important fruit tree species for farm production, to meet local consumption needs. We here present this approach and illustrate it with data from a case study involving Western and Eastern Kenya. The approach uses mixed methods to capture on-farm fruit tree diversity and seasonality at a household level (n = 600 in our case study), the months of household’s food security and insecurity (n = 600) and food consumption patterns at an individual level, to identify dietary gaps (n = 294 women and child pairs in our example). In our case study, 31 fruit tree species were reported on farms in our Western Kenya sample (9 of which were indigenous) and 51 (27 indigenous) in Eastern Kenya. In addition, the median number of food-insecure months per household was four (ranging from 0 to 9 months) in Eastern Kenya and three (0 to 12 months) in Western Kenya. Finally, using 24-h recalls the proportion of women that had consumed a fruit the day before the interview was around 55% in Western Kenya and 80% in Eastern Kenya, with consumption averaging 93 and 131 g, respectively. Using these parameters for each site and fruit tree phenology and food composition data sets, we derived context-specific recommendations that involve promoting 11 fruit tree species to address micronutrient gaps.

How to Effectively Enhance Sustainable Livelihoods in Smallholder Systems: A Comparative Study from Western Kenya

Increasing communities’ adaptive capacity is crucial to enhancing the sustainability of livelihoods and landscapes in smallholder systems. This study evaluates the contributions of an asset-based community-driven local development project, which has an objective to enhance farmer livelihoods through context-specific agricultural and agroforestry training, in line with farmers’ identities, interests, and preferences. The project was implemented in two areas of the wider Nyando river basin: the Lower and Middle Nyando sites. The project effects on farmer livelihoods were evaluated by analyzing overall income enhancement through the adoption of climate-smart agricultural practices via the computation of total values of harvest. Socioeconomic data from 183 households, half of which were involved in the project, were considered. The findings showed that locality played an important role in the adoption and success of good agricultural practices. Additional significant positive factors included project participation, size of land operated, horticulture farming, livestock ownership, ownership of a title deed, hours worked, and crop species richness. The number of years farmed had a significant negative correlation with the value of harvest. Considering the stark differences in livelihood effects in both sites, researchers conclude that external support for climate-smart agriculture uptake needs to be considerate of, and respond to, biophysical and socioeconomic context.